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This case report aims to describe the clinical presentation, imaging findings, diagnostic challenges, and management of a patient with a cerebellopontine angle lesion. A 63-year-old woman presented with progressive headaches, tinnitus, right ear pressure, and dizziness. Initial imaging studies (computed tomography and magnetic resonance imaging) suggested either a thrombosed aneurysm or a lipoma. However, advanced imaging with cone beam computed tomography provided a definitive diagnosis of temporal bone exostosis. This case highlights the importance of cone beam computed tomography in diagnosing complex intracranial lesions due to its superior spatial resolution and lower radiation dose.
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Background: A traumatic arteriovenous fistula of the scalp due to hair transplantation (AVFHT) is a rare fistulous communication between branches of the arteries and draining veins in the scalp's subcutaneous tissue. Its incidence is unknown and its clinical manifestations may range from a pulsatile mass to seldom epilepsy. Surgery and interventional approaches (percutaneous and endovascular embolization) using coils and embolic agents such as Onyx have been used as treatment options. The authors report a rare case of an AVFHT successfully treated through percutaneous and endovascular embolization using coils and precipitating hydrophobic injectable liquid (PHIL) embolic agent. This is possibly the first reported case using PHIL embolic agent to treat an AVFHT. Case Description: The patient presented with a painful and disabling scalp swelling in the right parieto-occipital region 2 years after a hair transplant in 2011. A computed tomography angiography showed an arteriovenous fistula between branches of the right superficial temporal artery and branches of the right occipital artery to the right superficial temporal vein that was successfully embolized using coils and PHIL. The patient was discharged after a smooth recovery and 1 month later remained healthy. Conclusion: Percutaneous and endovascular embolization using PHIL embolic agent can be an alternative treatment for AVFHT.
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Totally implanted central venous port systems are widely used to access central veins for patients needing long-term therapy. These devices have low rates of complications and are commonly used to administer medications like chemotherapeutic agents. Spontaneous rupture of a catheter segment is a rare mechanical complication, usually belatedly diagnosed and presenting with complications. We present a case of a spontaneously ruptured chemotherapy catheter diagnosed using a novel approach via oblique projections on chest X-rays and successfully removed using an endovascular approach.
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A pneumothorax is the abnormal gas accumulation within the pleural space. We present a case of a patient with an occult iatrogenic pneumothorax who presented with symptomatic anemia that substantially improved after a transfusion, diverting the clinical suspicion. As a result, she developed acute respiratory distress, initially considered secondary to a possible pulmonary embolism vs. fat embolism. After computed tomography confirmed the diagnosis, a chest tube was inserted. This case emphasizes the importance of suspecting pneumothorax secondary to cosmetic procedures and using computed tomography as the first diagnostic tool in complex cases since chest x-rays can miss pneumothorax.